Background.A helicopter emergency medical service (HEMS) is a specialist flying emergency service where on-board medical personnel have both the knowledge and equipment to perform complicated medical procedures. The paucity of literature describing the types of patients flown by HEMS in South Africa (SA) and their clinical outcome poses a challenge for current aeromedical services, as there is no baseline information on which to base flight criteria, staffing and policy documents. This has the potential to hamper the advancement of HEMS in SA. Objectives. To undertake a descriptive analysis of patients flown by the Netcare 911 HEMS over a 12-month period in Gauteng and KwaZulu-Natal (KZN) provinces, SA, and to assess patient outcomes. The clinical demographics of patients transported by the HEMS were analysed, time frames from dispatch of the helicopter to delivery of the patient to the receiving hospital determined, and patient outcomes at 24 hours and 72 hours analysed. Methods. The study utilised a retrospective quantitative, descriptive design to analyse patients transported by a private HEMS in SA. All complete records of patients transported by the Netcare 911 HEMS between 1 January and 31 December 2011 were included. Results. The final study population comprised 537 cases, as 10 cases had to be excluded owing to incomplete documentation. Of the 537 cases, 82 (15.3%) were managed by the KZN HEMS and 455 (84.7%) by the Gauteng HEMS. Adult males were the patients most commonly flown in both Gauteng and KZN (350/455 patients (76.9%) in Gauteng and 48/82 (58.5%) in KZN were males, and 364/455 patients (80.0%) in Gauteng and 73/82 (89.0%) in KZN were adults). Motor vehicle collisions were the most common incidents necessitating transport by HEMS in both operations (n=193, 35.9%). At the 24-hour follow-up, 339 patients (63.1%) were alive and stable, and at the 72-hour followup, 404 (75.3%) were alive and stable. Conclusions. The study findings provided valuable information that may have an impact on the current staffing and authorisation criteria of SA HEMS operations.
The Professional Board for Emergency Care at the Health Professions Council of South Africa (HPCSA) has approved pre-hospital rapid sequence intubation (RSI) as part of the scope of practice for registered emergency care practitioners (ECPs).RSI is an advanced airway management process that facilitates endotracheal intubation in adults and children. Features of this technique include pre-oxygenation, rapid pharmacological induction of unconsciousness, and neuromuscular blockade to enable the placement of an endotracheal tube.RSI has become widespread as the procedure of choice for definitive airway management by pre-and in-hospital emergency care personnel worldwide. In the emergency department setting, RSI is superior to intubation with deep sedation, a technique not incorporating pharmacological paralysis as part of the intubation sequence. For this reason, the implementation of RSI in the prehospital environment is supported, provided that it is practised within an appropriate framework of clinical governance. Position statementThis statement is endorsed by the Emergency Medicine Society of South Africa (EMSSA) and the Resuscitation Council of Southern Africa, and reflects pre-hospital RSI teaching and practice by the Department of Emergency Medical Care at the University of Johannesburg and the Division of Emergency Medicine at the University of the Witwatersrand.Pre-hospital RSI provides improved intubating conditions compared with intubation with deep sedation only, takes less time for intubation, and uses a safer combination and dosage of drugs. RSI also has risks; using neuromuscular blocking agents has potential complications because of the removal of spontaneous respiratory effort and possibly the loss of airway patency under certain circumstances. Nonetheless, the overall benefits of this technique outweigh the risks.Although the HPCSA has communicated some minimum standards about training and system and clinical governance requirements for pre-hospital RSI, these lack the necessary detail to allow adequate preparation for its implementation. To provide pre-hospital RSI safely and effectively, the following three aspects require consideration. TrainingPre-hospital RSI demands the application of knowledge, understanding and skill, and it requires the practitioner to reason logically, make sound clinical decisions and solve problems. The endpoint of each component of training should be demonstrated proficiency. Training and assessment should incorporate the following:Theoretical knowledge, focusing on the understanding of RSI procedures including indications, contraindications, and clinical decision-making and its influencing factors, particularly under emergency conditions. Simulated practice of RSI and related skills, including scenarios involving application of the abovementioned theoretical outcomes. These should be assessed by simulation exercises to ensure the safe application of a staged approach to airway difficulty.Clinical practice of RSI and related skills that should involve RSI performed in...
IntroductionThe consequences of spinal injury as a result of trauma can be devastating. Spinal immobilisation using hard trauma boards and rigid cervical collars has traditionally been the standard response to suspected spinal injury patients even though the risk may be extremely low. Recently, adverse events due to the method of immobilisation have challenged the need for motion restriction in all trauma patients. International guidelines have been published for protection of the spine during transport and this article brings those guidelines into the South African context.RecommendationsTrauma patients need to be properly assessed using both an approved list of high and low risk factors, as well as a thorough examination. They should then be managed accordingly. Internationally validated assessment strategies have been developed, and should be used as part of the patient assessment. The method of motion restriction should be selected to suit the situation. The use of a vacuum mattress is the preferable technique, with the use of a trauma board being the least desirable.ConclusionThe need for motion restriction in suspected spinal injury should be properly evaluated and appropriate action taken. Not all trauma patients require spinal motion restriction.
Search and rescue (SAR) personnel may be required to wear and carry external loads during a task. These external loads may be carried in austere environments across unpredictable terrain. Like other tactical occupations (military, law enforcement, fire, and rescue), SAR loads can range from ≥20 to 45 kg. Not only are these loads known to cause a variety of injuries to the musculoskeletal, integumentary, and neurological systems of the carrier, but these loads are also known to impede task performance and have ultimately led to mission failure. Ensuring personnel are physically capable of carrying external loads on tasks is critical to mitigating these potential risks of injury and performance decrements. Optimal load carriage conditioning, following the known frequency, intensity, time, and type of training formula would see SAR personnel conduct a load carriage specific session every 7 to 14 days, with load weights, walking speeds, and durations akin to those typical of their SAR requirements. The terrain types (inclusive of grade and nature of terrain) should likewise form part of this conditioning process. In addition to load carriage-specific sessions, improving strength (notably relative strength) and aerobic fitness should also optimize the load carriage conditioning of SAR personnel.
Introduction: A Helicopter Emergency Medical Service (HEMS) is a specialist flying emergency service where on-board medical personnel have both the knowledge and equipment to perform complicated medical procedures. There is an absence of literature describing the types of patients treated and the clinical outcome of these patients flown by Helicopter Emergency Medical Services within South Africa. The paucity of literature on this topic poses a challenge for current aeromedical services as there is no baseline information on which to base flight criteria, staffing and policy documents. This has the potential to hamper the advancement of HEMS within South Africa. Purpose of the study: The purpose of this study was to undertake a descriptive analysis of the patients flown by the Netcare 911 HEMS over a 12 month period in both Gauteng and KwaZulu-Natal and to assess the patients’ outcomes. The objectives of the study were to analyse the clinical demographics of patients transported by the Netcare 911 HEMS operation, determine the time frames from dispatch of the helicopter to delivery of the patient to the receiving hospital and undertake a correlational analysis of crew qualifications, clinical procedures performed and their outcomes at 24 hours and 72 hours. A further objective was to make recommendations regarding the refinement of current aeromedical policies as well as the education and training requirements. Methodology: The research study was conducted utilizing a retrospective quantitative, descriptive design to undertake an analysis of patients transported by a private helicopter emergency medical service within South Africa. The records of all patients transported by the Netcare 911 HEMS operations between 01 January 2011 and 31 December 2011 were included. Results: In the 12 month study period there were a total of 547 cases. However, the final study population was made up of 537 cases as 10 cases had to be excluded due to incomplete documentation. Of the 537 cases, 82 (15.3%) were managed by the KwaZulu-Natal HEMS and 455 (84.7%) were managed by the Gauteng HEMS. Findings revealed that the majority of patients flown in both Gauteng and KwaZulu-Natal were adult males: males (n=398; 74.1%) and adults (n=437; 81.4%). Motor vehicle accidents were the most common incident type for both operations (n=193; 36%). At the 24-hour follow up, 339 (63.1%) patients were alive and stable and at the 72-hour follow up, 404 (75.3%) were alive and stable. Conclusion and recommendations The findings of this study provide valuable information that may have an impact on the current staffing and authorization criteria of South African HEMS operations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.